Dr. Yen-Chau Nguyen

University of Montreal

Dr. Alyson Ruan

University of Toronto

A Survey of Current Teaching Practices Related to Special Health Care Needs Dentistry in Undergraduate and Graduate Pediatric Dentistry Programs in Canada and the United States of America

Dr. Alyson Ruan (Pediatric Dentistry MSc Student, University of Toronto)

Alyson Ruan, Olaf Plotzke, Paul Andrews, Sonica Singhal

University of Toronto, Faculty of Dentistry

Objectives: To describe current teaching practices related to Special Health Care Needs (SHCN) dentistry in undergraduate and graduate pediatric dental education programs in Canada and the United States of America (U.S.A.). To report programs’ perceived compliance with the Commission on Dental Accreditation’s applicable standards.

Methods: A cross-sectional online survey was distributed to educators or program directors responsible for SHCN dentistry teaching in accredited undergraduate and graduate pediatric dental programs in Canada and the U.S.A. using REDCap. A total of 190 programs were included. Descriptive statistics were calculated. Exploratory comparisons between pooled undergraduate and pooled graduate records were conducted, with country-specific subgroup results presented descriptively.

Results: 42 programs have participated in the survey (22% response rate). SHCN training was reported in 21/22 (95.5%) undergraduate and 18/20 (90.0%) graduate programs. At the undergraduate level, training hours were variable but overall limited, with Canadian programs reporting lower median didactic exposure than U.S.A. programs (<10 hours vs 10-19 hours). Treatment exposure was significantly greater in graduate programs, with reported treatment time of 50 or more hours compared with 10-19 hours in undergraduate programs. Graduate programs more often reported hospital-based training settings than undergraduate programs (94.4% vs 38.1%). Autism spectrum disorder, medical syndromes, intellectual impairments and developmental delays were universally covered across programs, while Alzheimer’s disease was among the least commonly taught SHCN conditions, particularly in graduate programs. Tell-Show-Do, positive reinforcement, and distraction were universally taught across responding programs, while oral sedation and active protective stabilization were among the least commonly taught behavior management techniques. Full compliance with the accreditation standards was reported more often by graduate than undergraduate programs (90.0% vs 59.1%), while undergraduate programs more often cited curriculum overload and limited faculty expertise as barriers.

Conclusions: Although SHCN dentistry was reported by most responding programs, undergraduate training appeared more limited and variable than graduate training. Standardization of curricular content and clinical exposure, particularly at the undergraduate level, may help better prepare future dentists to care for patients with SHCN.

Dr. Yu-Xin Shen

University of British Columbia

The Impact of Prolonged Recall Intervals on Oral Health Outcomes at a Pediatric Hospital Dental Clinic

Yu Xin Shen 1,2, Jennifer C. Park2 and Joy M. Richman 1,2

Faculty of Dentistry, University of British Columbia1, British Columbia Children’s Hospital2, Vancouver, Canada.

Objectives: There is currently weak and uncertain evidence regarding the optimal duration between dental recall visits for children. The goal of this study is to determine whether the time interval between dental recalls significantly affects oral health outcomes in a hospital dental clinic setting.

Methods: A retrospective chart review (H25-01120; Jan 2018 – Dec 2025) identified 315 patients who had at least two dental recall visits drawn from 1,882 patient charts. Patients who experienced a prolonged recall interval of  23 months (Long Interval), exacerbated by COVID-19 service interruptions, were compared to patients seen at the standard of care interval ≤ 12-month intervals (Standard Interval). A sub-analysis within the Long Interval group compared patients who required a mid-interval dental rehabilitation under general anesthesia against those who did not. Independent variables include ASA classification, age, the need for support for daily living (high vs. low), oral hygiene practices. Dependent variables included DMFT, gingivitis. Data were analyzed using Fisher’s Exact and Mann-Whitney U test.

Results: Of the 315 charts reviewed, 129 patients experienced a Long Interval, reflecting pandemic-related suspensions. Long Interval patients were significantly more likely to exhibit higher DMFT than the Standard Interval group. The reason for this difference is that 32.6% of the long interval group had a full mouth rehabilitation under general anesthesia between the first and second recall. In contrast the standard recall interval group had lower caries risk and only 3.2% required general anesthesia. We noted that those in the long recall interval were significantly more likely to require greater supports for daily living (p = 0.0036) and to require supervised brushing (p = 0.03). Within the Long Interval cohort, those that experienced treatment under general anesthesia prior to their second recall had less active decay than the non-restored group (0.10 vs. 0.69; p = 0.01).

Conclusion: We have determined that recall intervals of less than 12 months support better oral health outcomes. However, there are family related reasons underlying the longer recall intervals that have been uncovered here. We showed that dental caries experience was significantly greater for a subset of children with high support needs, underscoring the clinical necessity of prioritizing standardized recall intervals to mitigate disease progression (with regular fluoride application, diet counselling, tooth brushing instructions).

Previous dental intervention among emergency patients presenting with facial cellulitis of odontogenic origin to a tertiary pediatric hospital

Dr. Dana Smith

Smith D, Oxner JE, Singhal S, Barrett EJ, Garisto GA

Faculty of Dentistry, University of Toronto

Department of Dentistry, The Hospital for Sick Children

Objectives: Although facial cellulitis of odontogenic origin (FCOO) is a common pediatric dental emergency, little is known about the dental treatment history of offending teeth prior to presentation. This study aimed to determine the prevalence and characteristics of previous dental intervention among offending teeth in children presenting to the Emergency Department (ED) at The Hospital for Sick Children (SickKids) with FCOO.

Methods: Retrospective data from SickKids ED visits were collected between January 1, 2011 to December 31, 2025. Children aged 0–18 years who were residents of Ontario and presented to the ED with FCOO were included. Demographic and clinical variables including age, sex, socioeconomic status, offending tooth, trauma history, radiographic findings, restoration type, restorative material, and previous pulp therapy were collected. Information about socioeconomic status was also collected using the Ontario Marginalization Index (ON-Marg). Statistical analyses included descriptive statistics, t-test, logistic regression and Fisher’s exact test.

Results: A total of 1,228 patient encounters were reviewed, of which 571 met the inclusion criteria for FCOO. A previous dental intervention involving the offending tooth was identified in 275 (48%) cases. Among teeth with a history of previous dental intervention, 185 (67%) were a multi-surface restoration, and 225 (82%) were composite resin material. In the posterior primary dentition, multi-surface restoration had significantly higher odds of use than one-surface restoration (OR = 18, 95% CI = 5.17 – 61.39), and extra coronal restoration (OR = 19, 95% CI = 5.65 – 62.44). Children with lower socioeconomic status, measured by the ON-Marg material resource dimension, had lower odds of having a previous dental intervention before presenting with FCOO (OR = 0.80, 95% CI = 0.68 - 0.93).

Conclusions: Having a previous dental intervention contributed to nearly one-half of children presenting to SickKids ED with FCOO. The high prevalence of previous dental intervention suggests that receiving initial dental treatment alone may not be sufficient to prevent progression to severe odontogenic infection. Children from lower socioeconomic backgrounds were less likely to have received previous dental intervention, highlighting known disparities in access to dental care. Characterizing the dental treatment history of offending teeth may help clinicians with strategies to improve pediatric dental care and reduce emergency presentations.